Volunteer Training Handbook · purpose of this handbook is to support your learning as you progress through the seven chapters of the DVD training resource. The seven chapters in

Volunteer Training HandbookA Person Centred Care Volunteer Training Program

2

AGENCY FOR CLINICAL INNOVATION

Level 4, Sage Building

67 Albert Avenue

Chatswood NSW 2067

PO Box 699 Chatswood NSW 2057

T +61 2 9464 4666 | F +61 2 9464 4728

E [email protected] | www.aci.health.nsw.gov.au

SHPN (ACI) 150009

ISBN 978-1-76000-009-7

Further copies of this publication can be obtained from Agency for Clinical Innovation website at: www.aci.health.nsw.gov.au

Disclaimer: Content within this publication was accurate at the time of publication.

This work is copyright. It includes copyright Help Sheets from Alzheimer’s Australia and copyright Fact Sheets from Alzheimer’s Society UK. It may be reproduced in whole or part for study or training purposes subject to the inclusion of an acknowledgment of the source.

It may not be reproduced for commercial usage or sale. Reproduction for purposes other than those indicated above, requires written permission from the Agency for Clinical Innovation.

© Agency for Clinical Innovation 2014

Dementia and Delirium Care Hospital Volunteer Training © Agency for Clinical Innovation 2014 3

CONTENTS

Introduction ...................................................................................................................... 4

Pre Education Questions .................................................................................................. 5

Chapter 1: About the Program and the Volunteer Role ....................................................... 6

Chapter 1: Additional reading ......................................................................................... 7

Chapter 2: Understanding Dementia and Delirium ............................................................ 12

Chapter 2: Additional reading ....................................................................................... 13

Chapter 3: Communication and Person Centered Care ...................................................... 26


Chapter 4: Activities for patients ...................................................................................... 31


Chapter 5: Understanding behaviours which can occur in patients with dementia and delirium ... 33


Chapter 6: Assisting patients with eating and drinking ...................................................... 50

Chapter 6: Additional reading ........................................................................................51

Chapter 7: Safe walking with patients ............................................................................... 56

Post Education Questions .............................................................................................. 58

Dementia & Delirium Care Hospital Volunteer Training DVD Evaluation.................... 59

Quiz Answers .................................................................................................................. 62

Dementia and Delirium Care Hospital Volunteer Training © Agency for Clinical Innovation 20144

INTRODUCTION

This Volunteer Training Handbook accompanies the Dementia & Delirium Care Hospital Volunteer Training DVD. The

purpose of this handbook is to support your learning as you progress through the seven chapters of the DVD training

resource.

The seven chapters in the Dementia & Delirium Care Hospital Volunteer Training DVD are:

•Introductiontotheprogramandthevolunteerrole.

•Understandingdementiaanddelirium.

•Communicationandpersoncentredcare.

•Activitiesforpatients.

•Changedbehaviourswhichcanoccurinpatientswithdementiaanddelirium.

•Assistingwitheatinganddrinking.

•Safewalkingwithpatients.

This handbook has seven sections based on each DVD chapter. Each section has additional optional reading. There is also

a short quiz for you to complete at the end of each chapter.

The quiz is not a test you will be marked on, it is designed to support you in your learning as you progress through each

chapter of the DVD. Once you have completed the quiz for each chapter you can check the correctness of your answers

with answers at the end of the training handbook.

How to use this DVD resource

There is a lot of information covered in this training DVD and you are not expected to absorb it all at once. It is suggested

that you watch one or two chapters at a time, review the reading resources and then complete the quiz before going onto

the next chapter. You may even want to watch the DVD more than once. Each person will be different. If you feel you need

to keep the DVD longer to view it again do not hesitate to ask the person overseeing your training.

Evaluation of the DVD

To assist in evaluating the effectiveness of the DVD training resource, a pre and post education questionnaire is included

in the handbook to measure your confidence in caring for patients with memory and thinking problems both before and

after watching the DVD.

The lift out pre education questionnaire is at the beginning of chapter 1 and the post education questionnaire at the end

of chapter 7.

We would also value your feedback on how useful you have found this DVD training resource as well as any suggestions

you may have for improvement. For this reason there is also a short evaluation form for you to complete at the end of

chapter 7.

The questionnaires and survey are anonymous.

Please return the pre post questionnaire and DVD evaluation form to the person responsible for your training when you

return the DVD.


Not confident at all Moderately confident Very confident

1 2 3 4 5

Date: ___/___/_____

Please answer the following questions, by circling the number that best reflects your response.

1. How confident are you that you understand what dementia is?

Not comfortable at all Moderately comfortable Very comfortable

1 2 3 4 5

2. How comfortable do you feel about the idea of spending time with a person with dementia?

Very unsure Moderately confident Very confident

1 2 3 4 5

3. Sometimes, when a person with dementia becomes stressed or anxious, they can become upset, angry or aggressive. How confident would you feel interacting with someone with dementia who demonstrated these behaviours?


1 2 3 4 5

4. How confident are you that you understand what delirium is?


1 2 3 4 5

5. How comfortable do you feel about the idea of spending time with a person with a delirium?


1 2 3 4 5

6.Sometimes, when a person with a delirium becomes stressed or anxious, they can become upset, angry or aggressive. How confident would you feel interacting with someone with dementia who demonstrated these behaviours?


1 2 3 4 5


PR

E E

DU

CA

TIO

N Q

UE

ST

ION

S

PRE EDUCATION QUESTIONS



CHAPTER 1: ABOUT THE PROGRAM

AND THE VOLUNTEER ROLE

What this chapter covers •Overviewandpurposeofthevolunteerprogram.

•Thespeciicroleofthevolunteerinsupportingpatientcare.

•Interactionwithstaffaspartofthecareteam.

•Thevalueofthevolunteerroleforpatients,familycarersandstaff.

•Thetypesofpatient’svolunteerswillbesupporting.

•Theprocessofreferralforvolunteersupport.

•Importantconsiderationssuchasrolesandresponsibilitiesandconidentiality.

•Deinitionofavolunteer.

•Theexperienceofexistingvolunteers.

Additional information/reading included 1. Referral and Eligibility Form.

2. Volunteer Duty Statement.

3. Rights and Responsibilities.

4. Do’s and Don’ts for Volunteers.

Chapter 1 QuizPlease circle the correct true or false response

1. The types of patients volunteers will be supporting include those who

memory and thinking problems.

True False

2. The volunteer role provides similar support to that of a family carer. True False

3. Reading and signing the code of conduct is a requirement for all health

service staff and volunteers.

True False

4. If a referral form has not been completed the volunteer can still provide

assistance to the patient.

True False

5. Maintaining confidentiality relates only to information about the patient. True False

Check your answers with those at the end of the handbook

CH

AP

TE

R 1


Chapter 1: Additional Reading

Referral and Eligibility form

Hospital Volunteer Program

Referral and eligibility checklist

Date: ___/___/_______

Ward:_______________ Room: _____

SURNAME UNIT NO/UAID FIRST NAMES DOB SEX

AFIX PATIENT LABEL

Patients are not suitable and excluded from the program if: 1. The patient has behaviours that would place a volunteer at risk (eg; Hitting out or

physical aggression)

2. The patient or carer has declined to have a volunteer visit.

All information below MUST be completed to ensure the safety of both the patient and volunteer

CRITERIA FOR PROGRAM (circle response)

Patient is aged >65 years (or if aboriginal > 45 years) AND YES NO

Scored 24/30 or less on SMMSE or 7/10 or less on AMT YES NO

OR Patient has a diagnosis of dementia or obvious memory and /thinking problems YES NO

OR Is positive for suggested Delirium with Confusion Assessment Method YES NO

OR Patient is >65 (> 45 ATSI) AND has one or more of the following delirium risk/precipitation factors

Please tick: Severe medical illness ( ) Dehydration ( ) Alcohol dependant ( )

Depression ( ) #NOF ( ) Visual impairment ( ) Hearing impairment ( )

DELIRIUM ALERT has been placed in patients MR folder YES

CONSENT is required before the allocation of a volunteer.

Verbal patient or carer consent obtained NOTE: Where consent cannot be immediately obtained and the patient who meets the referral criteria is in

need of urgent volunteer support the NUM/RN in charge can refer to the program pending consent.

YES

Additional information required from nursing staff to advise volunteers on patient requirements.

Volunteers cannot accept patients without this information

Specific suitability considerations;

Does the patient have communication difficulties that would prevent them from talking

to a volunteer (eg aphasia)

YES NO

Does the patient require Personal Protective Equipment? YES NO

Is the patient safe to be walked with a volunteer? YES NO

Does the patient need reorientating? YES NO

Does the patient need assistance with eating and drinking YES NO

If yes- type of assistance: Menu completion ( ) Set up and supervision ( ) Full assist ( )

Is the patient on thickened fluids? YES NO

Does the patient need fluids encouraged? YES NO

Is the patient on restricted fluids? YES NO

Is the patient on a Fluid Balance Chart? YES NO

Are there any special diet or other needs for this patient that the volunteer should know YES NO

IF YES please specify :

Name: ___________________ Designation: _________ Signature:______________

Please place completed form in the Volunteer Referral folder <insert location>

CH

AP

TE

R 1

: A

DD

ITIO

NA

L R

EA

DIN

G


DUTY STATEMENT FOR Dementia & Delirium Care Hospital Volunteers

Volunteer Duties

1. W��

�� d

2. V��

v�� d

3. T�� v�� v��

�� d

4. In the circumstance where information about the patients feeding, fluids and walking needs are not completed in the referral form, volunteers are not to accept patients to the program until the referral form is completed clarifying this.

5. T�� v�� s ��

�� s �� d b�� b�� v��s � �� A � �� l ��

s �� m� �� v��

�� M��

�� sd T�� v�� A � �� s ��

��

A � �� A��s�� v� �� s ��

�� s �� d b�� v�� s ��m�s �� s��

�� d

U �� s ��

��d C�� s �� s �� t� �� C�� UMd C�� t� �� s ��

�� v�� v�� ROLE RESPONSIBILITIES The volunteer is:

1. t� �� s ��v��s ��

�� v��s �� d

2. T� �� s �� v�s �� s� ��

�� v�� v��s ��s

3. T� �� d�d ��

�� d

Volunteer Duty Statement

CH

AP

TE

R 1

: AD

DIT

ION

AL

RE

AD

ING


4. �� !"��#�$ �"� ��%!� %� �"� ��%��$ �� "� &'( �� )& %� !"��#�*

5. �� +�,� �"�+$�-,�$ .��+ �� %��$ �"� .��- /�!�+.��0-� �� /�$�.� 1%�"

��a �� "%$ �� "� )& %� !"��#� �� &'(

6. �� "�2��a�/$ %�!%a��$ �"� %a��%. �� "� &'( �� )& %� !"��#� ��a

!�+�- 1%�" +��/�- "��a-%�# $+�� -%.� ��!�%!�$*

7. �� a"�� "��a 1�$"%�# ��a "��a " #%�� a ��"�� 3/%��a %�.�!�%�� !��-

��!�%!�$ p�$ a%��!��a 0 $��..4 1"�� ,%$%�%�# ��%��$*

8. To k�� !��a �. �%+� $��5 �!�%,%�%�$ !��a/!��a �"� ��$��$� �. ��%��$ ��

�"�$� �!�%,%�%�$5 ��a �� "�� -�,�� %�.��+��%�� !" $"%.�*

9. �� +�%��%� !��%�$ �. ,�-/�� #��+ a�!/+��%��*

10. 6"�� -�,��5 �� k�� a ��!��a ��a !�++/�%!�� "� RN �� NUM �"��7%+�� +�/��$ �. .-/%a$ �"� ��%�� "�$ 1"%-� 1%�" �"� ,�-/��5 �"� -�,�- �.

+��- �$$%$��!� ��a "�1 +/!" �. �"�%� +��- �"� ��*

11. �� !��a ��-�,�� %�.��+��%�� 0�/� �"� ��%��$ ��a �"�%� 0�"�,%�� %� �"� ,�-/��

��!��a a�!/+��%�� a �� !"��#�a 0�"�,%�/� �� "� )& %� !"��#� ��

NUM

12. &�� a �"�%� $"%.� %. �"� �� have a cold, ��"�� $�%�� %�.�!�%��

#��-- /�1�--*

13. &�� a �"�%� $"%.� %. �"� �� $/..��%�# .��+ � 0�/� �. #�$��%�%$* N� �"%$

!%�!/+$��!� �"� ,�-/�� $"�/-a �� /�� "� "�$�%��- /��%- c8 "�/�$ �.�� "�%�

-�$� ��%$�a� �. ,�+%�%�# �� a%��"��* 14. �� #� � $/0$�%�/�� .�� %. 9�-/�� :��a%��;$ �� "�$�%��- $��.. �.

�� /��-��a �0$��!�$

15. �� a $/��,%$%��5 a� 0�%�.%�#5 ��#�%�# �a/!��%�� a $/�� +��%�#$ As a Hospital Volunteer, I agree to the duties, roles and responsibilities in this duty:

S%#��a __________________________ &�+� �. 9�-/��

________________________ D��< ===;====;=======

S%#��a ___________________________ &�+� �. S/��,%$��;!��a%�� __________________________ D��< ===;====;=======

CH

AP

TE

R 1

: A

DD

ITIO

NA

L R

EA

DIN

G


Rights and Responsibilities for Volunteers

The Volunteer has the right to: • E>?@BF GHI@JFKFIGJ FG FL@ O@HPIB@ FLKF IJBQRX@Y Z@GZHK?LIB QK[GRF\ IJFHGXRBFIGJ FG

BQI@JFY KJX YFK]] KJX

• H@Q@PKJF IJ]GHrKFIGJ^ _L@ `GQRJF@@H rK[ ]IJX e@J@]IF IJ LKPIJZ K feRXX[f KQQGBKF@X

]HGr FL@ YFK]] FG

• KYg hR@YFIGJY GH @>?H@YY BGJB@HJY^ • i@ ?HGPIX@X jIFL IJIFIKQ KJX GJZGIJZ FHKIJIJZ^ • i@ H@ZKHX@X KY K BGnjGHg@H IJ FL@ B@JFH@^

• E>?@BF YR??GHF KJX ZRIXKJB@ ]HGr FL@ `GQRJF@@H oGnGHXIJKFGH KJX YFK]]^

• i@ KQQGBKF@X FG K YRIFKeQ@ KYYIZJr@JF\ jIFL BGJYIX@HKFIGJ ]GH ?@HYGJKQ ?H@]@H@JB@\

eKBgZHGRJX @>?@HI@JB@Y KJX Z@GZHK?LIB QGBKFIGJ^ • i@ FHRYF@X jIFL IJ]GHrKFIGJ FLKF jIQQ L@Q? IJ BKHH[IJZ GRF FL@ KYYIZJr@JF^

• qKP@ FL@IH IX@KY L@KHX H@ZKHXIJZ BLKJZ@Y IJ FL@ Y@HPIB@ FL@[ ?HGPIX@^ • uJGj jL@FL@H FL@IH jGHg IY @]]@BFIP@ KJX LGj IF BGRQX e@ Ir?HGP@X^ • wJXIBKF@ jL@J GRF G] ?GBg@F @>?@JY@Y KH@ FGG ZH@KF^ • xIP@ FL@IH YIX@ G] FL@ BKY@ FG FL@ `GQRJF@@H oGnGHXIJKFGH KJX yGH YFK]] I] FL@H@ KH@

hR@HI@Y GH BGr?QKIJFY^ • _Kg@ K LGQIXK[^ • _G LKP@ K ?KHFIBRQKH ?QKB@ FG ?RF e@QGJZIJZY\ @Z\ QGBg@H\ BR?eGKHX GH X@YIZJKF@X

YL@Q] Y?KB@^

• zKHFIBI?KF@ IJ KJ[ r@@FIJZY KJX Q@KHJIJZ G??GHFRJIFI@Y FLKF KH@ GHZKJIY@X ]GH

PGQRJF@@HY^

• O@@g KXPIB@ jL@J RJB@HFKIJ KeGRF FL@ HGQ@ GH FKYg^

The Volunteer has the responsibility to: • {GFI][ FL@ `GQRJF@@H oGnGHXIJKFGH GH YFK]] G] KeY@JB@Y^

• zHGPIX@ ]@@XeKBg\ YRZZ@YFIGJY KJX H@BGrr@JXKFIGJY H@ZKHXIJZ FL@ Y@HPIB@ KJX

FLRY IJBH@KY@ IFY @]]@BFIP@J@YY^ • |Y@ H@KYGJKeQ@ }RXZ@r@JF IJ rKgIJZ X@BIYIGJY jL@H@ FL@H@ IY JG ?GQIB[^ _G

XIYBRYY FLIY jIFL FL@ `GQRJF@@H oGnGHXIJKFGH GH YFK]] KY YGGJ KY ?GYYIeQ@^ • i@ X@?@JXKeQ@^ ~G jLKF [GR LKP@ KZH@@X FG XG^ ~G JGF rKg@ ?HGrIY@Y FLKF [GR

BKJJGF g@@?^

• _G e@ ?RJBFRKQ^

• WeKH K JKr@FKZ KJX RJI]GHr IY YR??QI@X^ • i@ K F@Kr ?QK[@H^

• �KIJFKIJ BGJ]IX@JFIKQIF[^

CH

AP

TE

R 1

: AD

DIT

ION

AL

RE

AD

ING


Dos and Don’ts: Dementia and Delirium Care with Volunteers

DO �� ef��

�� of�le. Comm��e �� h �� Tal� �� A�� d ��ppo�� ed pa�� e��pe�� h compl�� m�� R�� he �� o �he �� R�� o �he �� NUM �� e��d of ��me �� h �� , ��

��ge �� P��. �� o c��al�� vac� �� ol�� l�� of vol��

DON’T A�� f��m �� f�� m��

vol�� c�� NUM, �� h c��e of ��

al�� al� �� he NUM �� RN �� f �� ¡ �� e m��

��em�� ¢�� £ ��h f�� ¤�� em� f�� m�� om

�he N�� M�� ¢NUM£ �� oom �� cl�� ¥�� ec��

��oval f�om �he NUM �� RN �� ge. D�� a �� m�� h �hem, ��

��la��e� D�� of �he �� de of �he heal�h ��ce.

(ReVive, 2008)

CH

AP

TE

R 1

: A

DD

ITIO

NA

L R

EA

DIN

G

13

CHAPTER 2: UNDERSTANDING

DEMENTIA AND DELIRIUM

What this chapter covers •Dementiaisabroadtermusedtodescribeasetofsymptomsaffectingapersonsmemory,thinking,

emotions and their ability to do things they were once always able to do.

•Theonsetandprogressionofdementiavariesaccordingtothetypeofdementiabutingeneralitoccurs

slowly and gradually becomes worse over time.

•Deliriumisacommonconditionaffectingmostlyolderpeopleinhospitals.

•Deliriumisdifferentfromdementiainthatithasarapidonset.Itmostoftenhasamedicalcauseand

occurs much more commonly in people with dementia.

•Thehospitalenvironmentcanbequitefrighteningandstressfulforpeoplewithdementiaanddelirium.

•Volunteerscangreatlysupportpatientswithdementiaanddeliriumandtheirfamilycarers.

Additional reading/information 1. Alzheimer’s Australia Helpsheet – What is dementia?

2. Brain and Behaviour fact sheet.

3. Delirium family carer brochure.


1. Dementia can be cured. True False

2. Alzheimer’s disease is the most common cause for dementia. True False

3. Delirium is characterised by a sudden onset of change in a person’s mental

function.

True False

4. People with dementia and delirium can be anxious and fearful when in

hospital.

True False

5. It is important for volunteers to notify staff of any changes they notice in a

person’s mental state behaviour or physical condition.

True False


CH

AP

TE

R 2

14

ABOUT

DEMENTIA

NATIONAL DEMENTIA HELPLINE 1800 100 500FIGHTDEMENTIA.ORG.AU

WHAT IS DEMENTIA? This Help Sheet describes dementia, who gets it and some of its most common forms. It describes some early signs of dementia and emphasises the importance of a timely medical diagnosis.

Dementia describes a collection of symptoms that are caused by disorders affecting the brain. It is not one specific disease.

Dementia affects thinking, behaviour and the ability to perform everyday tasks. Brain function is affected enough to interfere with the person’s normal social or working life. The hallmark of dementia is the inability to carry out everyday activities as a consequence of diminished cognitive ability.

Doctors diagnose dementia if two or more cognitive functions are significantly impaired. The cognitive functions affected can include memory, language skills, understanding information, spatial skills, judgement and attention. People with dementia may have difficulty solving problems and controlling their emotions. They may also experience personality changes. The exact symptoms experienced by a person with dementia depend on the areas of the brain that are damaged by the disease causing the dementia.

With many types of dementia, some of the nerve cells in the brain stop functioning, lose connections with other cells, and die. Dementia is usually progressive. This means that the disease gradually spreads through the brain and the person’s symptoms get worse over time.

Who gets dementia?

Dementia can happen to anybody, but the risk increases with age. Most people with dementia are older, but it is important to remember that most older people do not get dementia. It is not a normal part of ageing, but is caused by brain disease. Rarely, people under the age of 65 years develop dementia and this is called ‘younger onset dementia’.

There are a few very rare forms of inherited dementia, where a specific gene mutation is known to cause the disease. In most cases of dementia however, these genes are not involved, but people with a family history of dementia do have an increased risk. For more information see the Help Sheet on About Dementia: Genetics of dementia.

Certain health and lifestyle factors also appear to play a role in a person’s risk of dementia. People with untreated vascular risk factors including high blood pressure have an increased risk, as do those who are less physically and mentally active. Up to date and detailed information about dementia risk factors is available at mindyourmind.org.au.

What causes dementia?

There are many different diseases that cause dementia. In most cases, why people develop these diseases is unknown. Some of the most common forms of dementia are:

Alzheimer’s disease

Alzheimer’s disease is the most common form of dementia, accounting for around two-thirds of cases. It causes a gradual decline in cognitive abilities, often beginning with memory loss.

Alzheimer’s disease is characterised by two abnormalities in the brain – amyloid plaques and neurofibrillary tangles. The plaques are abnormal clumps of a protein called beta amyloid. The tangles are bundles of twisted filaments made up of a protein called tau. Plaques and tangles stop communication between nerve cells and cause them to die. For more information see the Help Sheet on About Dementia: Alzheimer’s disease.

Vascular dementia

Vascular dementia is cognitive impairment caused by damage to the blood vessels in the brain. It can be caused by a single stroke, or by several mini-strokes occurring over time. These mini-strokes are also called transient ischaemic attacks (TIAs).

Vascular dementia is diagnosed when there is evidence of blood vessel disease in the brain and impaired cognitive function that interferes with daily living. The symptoms of vascular dementia can begin suddenly after a stroke, or may begin gradually as blood vessel disease worsens. The symptoms vary depending on the location and size of brain damage. It may affect just one or a few specific cognitive

1


CH

AP

TE

R 2

: A

DD

ITIO

NA

L R

EA

DIN

G

15

This publication provides a general summary only of the subject matter

covered. People should seek professional advice about their specific case.

Alzheimer’s Australia is not liable for any error or omission in this publication.

© Alzheimer’s Australia 2012

Reviewed March 2012

ABOUT

DEMENTIA

ABOUT

DEMENTIA

functions. Vascular dementia may appear similar to Alzheimer’s disease, and a mixture of Alzheimer’s disease and vascular dementia is fairly common. For more information see the Help Sheet on About Dementia: Vascular dementia.

Lewy body disease

Lewy body disease is characterised by the presence of Lewy bodies in the brain. Lewy bodies are abnormal clumps of the protein alpha-synuclein that develop inside nerve cells. These abnormalities occur in specific areas of the brain, causing changes in movement, thinking and behaviour. People with Lewy body disease may experience large fluctuations in attention and thinking. They can go from almost normal performance to severe confusion within short periods. Visual hallucinations are also a common symptom.

Three overlapping disorders can be included with Lewy body disease:

• Dementia with Lewy bodies

• Parkinson’s disease

• Parkinson’s disease dementia

When movement symptoms appear first, Parkinson’s disease is often diagnosed. As Parkinson’s disease progresses most people develop dementia. When cognitive symptoms appear first, this is diagnosed as dementia with Lewy bodies.

Lewy body disease sometimes co-occurs with Alzheimer’s disease and/or vascular dementia. For more information, see the Help Sheets on Lewy body disease.

Frontotemporal dementia

Frontotemporal dementia involves progressive damage to the frontal and/or temporal lobes of the brain. Symptoms often begin when people are in their 50s or 60s and sometimes earlier. There are two main presentations of frontotemporal dementia – frontal (involving behavioural symptoms and personality changes) and temporal (involving language impairments). However, the two often overlap.

Because the frontal lobes of the brain control judgement and social behaviour, people with frontotemporal dementia often have problems maintaining socially appropriate behaviour. They may be rude, neglect normal responsibilities, be compulsive or repetitive, be aggressive, show a lack of inhibition or act impulsively.

There are two main forms of the temporal or language variant of frontotemporal dementia. Semantic dementia involves a gradual loss of the meaning of words, problems finding words and

remembering people’s names, and difficulties understanding language. Progressive non-fluent aphasia is less common and affects the ability to speak fluently.

Frontotemporal dementia is sometimes called frontotemporal lobar degeneration or Pick’s disease. For more information, see the Help Sheet on About Dementia: Frontotemporal dementia, or visit the Frontier research group website ftdrg.org.

Is it dementia?

There are a number of conditions that produce symptoms similar to dementia. These can often be treated. They include some vitamin and hormone deficiencies, depression, medication effects, infections and brain tumours.

It is essential that a medical diagnosis is obtained at an early stage when symptoms first appear to ensure that a person who has a treatable condition is diagnosed and treated correctly. If the symptoms are caused by dementia, an early diagnosis will mean early access to support, information and medication should it be available.

What are the early signs of dementia?

The early signs of dementia can be very subtle and vague and may not be immediately obvious. Some common symptoms may include:

• Progressive and frequent memory loss

• Confusion

• Personality change

• Apathy and withdrawal

• Loss of ability to perform everyday tasks

What can be done to help?

At present there is no cure for most forms of dementia. However, some medications have been found to reduce some symptoms. Support is vital for people with dementia and the help of families, friends and carers can make a positive difference to managing the condition.

1

FURTHER INFORMATION

Alzheimer’s Australia offers support, information, education and counselling. Contact the National Dementia Helpline on 1800 100 500, or visit our website at fightdementia.org.au

For language assistance phone the Telephone Interpreter Service on 131 450

CH

AP

TE

R 2

: AD

DIT

ION

AL

RE

AD

ING

16

alzheimers.org.uk

The brain and behaviour

Alzheimer’s disease is a degenerative condition associated with

a progressive loss of nerve cells or neurons. The disease gradually

pervades most areas of the brain. However, the evolving pattern

of damage can vary greatly between different individuals. As a

result, each person with the disease may have a complex set of

dificulties and experiences that are unique to them.

This factsheet explains which areas of the brain are largely responsible

for which skills and abilities, and how the changes in behaviour,

memory and thought experienced by people with Alzheimer’s may be

a direct result of the way the disease has affected the brain.

Parts of the brain

The brain consists of three main

sections: the hindbrain, the

midbrain and the forebrain (see

Figure 1). The hindbrain and

midbrain are mainly concerned

with basic life support functions,

such as blood pressure and

respiration. In contrast, the

forebrain is responsible for the

majority of higher brain functions,

such as memory and language.

This factsheet concentrates on the

parts of the forebrain.

Figure 1: sections of the brain

Brian and Behaviour Fact Sheet

CH

AP

TE

R 2

: A

DD

ITIO

NA

L R

EA

DIN

G

17

The cerebral cortex

The most important part of the forebrain is the cerebral cortex – a thin shell covering the surface of the forebrain. This thin layer is tightly crumpled and folded, to increase its surface area. As a result, the cortex alone contains an astonishing ten billion brain cells (the ‘grey matter’). Beneath this densely packed cortex lie bundles of ibres (the ‘white matter’), which transport information around the cortex and to other brain regions (see Figure 2).

The lobes

To help us describe the different parts of the brain, the forebrain has been divided up into four sections, or ‘lobes’, shown in Figure 3.

•The occipital lobe is located at the back of the brain, and deals primarily with visual information from the eyes.

•The parietal lobe lies in the upper-rear portion of the brain, and is concerned with information about spatial relationships, perception and magnitude.

•The temporal lobe lies beneath the parietal lobe and is involved in memory and language.

•The frontal lobe can be thought of as our ‘executive’ or ‘management’ centre.

Figure 2: cross section of the motor cortex

Figure 3: the lobes

CH

AP

TE

R 2

: AD

DIT

ION

AL

RE

AD

ING

18

The hemispheres

In addition to being divided into lobes, the brain is also physically

divided into two halves or hemispheres: left and right. The

hemispheres are not entirely separate – they are connected by a large

bundle of ibres that allows them to talk to one another. While these

hemispheres look almost identical from the outside, one hemisphere

is usually dominant over the other. In all right-handed people, and

the majority of left-handed people, it is the left hemisphere that is

dominant.

Organising principles

There are certain principles that appear to govern the organisation

of the brain. The division between the hemispheres signals one of

these principles: lateralisation. Lateralisation literally means that

some functions are best performed by the left side of the brain, while

others are mainly supported by the right side. In the human nervous

system, the left hemisphere controls the right side of the body and

the right hemisphere controls the left side of the body. However, not

all functions are shared so equally. For example, language tends to

be a function of the dominant hemisphere of the brain (usually the

left side), with certain areas involved in language comprehension and

language production managed towards the front of the hemisphere.

Some areas of the brain are organised in a map-like order. For

example, the motor cortex, which sends movement instructions to

the muscles, is organised so that parts of the body that are physically

close (such as the hand and the wrist) are controlled by groups of

cells that are also near to one another (see Figure 2). Keeping related

information in one place in the cortex helps to keep the amount of

wiring between cells to a minimum, and so saves on space.

It would be a considerable understatement to say that the structure

of the brain is complicated. However, by studying behaviour and

cognitive abilities in people with both healthy and damaged brains,

scientists have been able to determine the principle functions of

different brain areas.

3

CH

AP

TE

R 2

: A

DD

ITIO

NA

L R

EA

DIN

G

19

The occipital lobe

Although the eyes are the source of visual information about the world

around us, it is actually the brain that does most of the hard work. The

eyes convert sensory information about light into electrical impulses,

but these are passed to the brain for interpretation. This division

of labour means we have to distinguish between visual acuity and

perception.

Visual acuity – the ability to see small objects – is achieved largely

by the workings of the eye itself. Perception is achieved by the

occipital and parietal lobes, with information about colour, shape and

movement being processed separately by the occipital cortex before it

is passed on to the parietal lobe for combination into a complete 3D

picture of the world.

This means that someone with dementia could have dificulty seeing

what an object is, despite both eyes being in perfect condition.

However, it is still necessary to maximise their eyesight (for example,

with correct prescription spectacles) so that the brain has as much

information to work with as possible. For more information, see

Factsheet 527, Visuoperceptual dificulties in dementia.

The parietal lobe

The functions of the parietal lobe are somewhat more diverse, and

there is a signiicant difference between the dominant and non-

dominant sides.

The dominant parietal lobe (usually the left half) can be thought

of as being concerned with things we have to put together into an

order or structure. So tasks such as reading and writing, which require

putting letters and words together, and calculation, which involves

ordering and combining numbers, are critically dependent on the

dominant parietal lobe. This side of the parietal lobe has also been

heavily implicated in a condition known as apraxia (an impairment

of learned purposive movements). ‘Dressing apraxia’ is the form of

apraxia most commonly noticed in people with Alzheimer’s disease,

CH

AP

TE

R 2

: AD

DIT

ION

AL

RE

AD

ING

20

and relects not only a lack of co-ordination but an actual forgetting

of the movements required to achieve a goal (fastening a button,

for example).

As if to compound such problems, the dominant parietal lobe is also

responsible for our body sense – that is, knowing our left from our

right, and sensing where one limb is in relation to the rest of our body.

The non-dominant parietal lobe (usually the right half), in contrast,

could be thought of as our ‘3D centre’. This part of the parietal lobe

receives visual information from the occipital lobe. The function of

this area is to combine such information into a 3D representation of

the object being viewed. Damage to this area leads to a symptom

known as ‘visual agnosia’ – an inability to recognise objects, faces

or surroundings. Because visual information is processed separately

from other modes of sensation, it is possible for individuals to fail to

recognise a familiar face by sight but to know who they are once

they speak.

The non-dominant parietal lobe also contributes to our understanding

of space but in a different way from its dominant counterpart. While

the dominant parietal lobe deals with our body sense or personal

space, the non-dominant portion helps us to locate objects in

external space, and to calculate the location of objects relative to

one another and ourselves (for example, when we are reaching to pick

something up).

The temporal lobes

The temporal lobes deal primarily with memory functions. The

dominant temporal lobe is specialised for verbal (word-based)

memory and the names of objects, while the non-dominant temporal

lobe is used for our memory of visual (non-verbal) material, such as

faces or scenes.

There are also different types of memory. Episodic memory, as

its name suggests, is our memory of events or episodes, which

are recorded with a reference to the time when they occurred

CH

AP

TE

R 2

: A

DD

ITIO

NA

L R

EA

DIN

G

21

(for example: ‘I ate eggs for breakfast this morning’). Meanwhile,

semantic memory can be thought of as our own encyclopaedia for

facts and igures (for example: ‘Eggs have a shell, are laid by hens, and

can be eaten boiled, scrambled or fried’).

In Alzheimer’s disease it is the episodic memory that is most

commonly damaged. It is not yet clear exactly how or where long-

term memories are stored, but it seems that memories are achieved

by strengthening the connections between relevant nerve cells. And it

does seem clear that some remote or distant memories, such as where

one went to school, are stored more deeply than less familiar or recent

memories, such as what one did yesterday. This may be because

certain poignant or important events have been re-remembered

many times over the years, and so are more rehearsed than recent

memories. This is why some people with Alzheimer’s disease may ind

it easier to discuss certain often-recalled aspects of their childhood

than what has happened that day.

The frontal lobe

The frontal lobe contains several parts, which all act together to form

our ‘executive’ or management’ centre. These parts carry out the

following activities:

Planning actions and learning new tasks – The lateral or outer

surfaces of the frontal lobe appear to be critical for organising and

planning our actions and learning new tasks. For example, in learning

to drive, these brain areas help us put together a very complex

sequence of movements that at irst seem dificult and clumsy but

gradually become more smooth and automatic. For someone with

damage to this area, it is like being a learner all over again. Many

multi-stage tasks, such as cooking and shopping, become very dificult

because the pattern, or plan of action, has been lost.

Damage to these lateral areas can also cause people to get ‘stuck’ on

what they are doing (known as ‘perseveration’). As the frontal lobe

interacts with many other brain areas, this perseveration may take the

form of using the same word over and over again, or taking one piece

CH

AP

TE

R 2

: AD

DIT

ION

AL

RE

AD

ING

22

of clothing out of a drawer and then unpacking all the other clothes

without a speciic purpose.

Motivation – Moving towards the division between the two

hemispheres, the middle portion of the frontal lobe generates

our motivation and general impetus. If this part of the brain is

affected, people can lose their ‘get up and go’, becoming lethargic

and reluctant to get out of bed or perform particular activities. It is

important to realise that what some might see as laziness could be a

direct consequence of the loss of cells in this area of the brain.

Regulation of behaviour – The regulation of our behaviour appears

to be governed by a third area of the frontal lobe, the orbitobasal

area, which is located in the curvature at the very front of the brain.

In healthy people, this part of the brain helps to monitor, control

and moderate our behaviour: for example, preventing us from saying

something rude if someone has annoyed us. In someone with

Alzheimer’s disease, this function may be damaged, which can lead to

a failure of inhibition.

Other areas and structures

Many areas of the cerebral cortex are concerned not so much with

supporting a speciic function, but with integrating and associating

the products of surrounding areas. A similar role is played by many

structures that lie beneath the cortex, such as the limbic system which,

among other things, permits memory and behaviour to inluence one

another. The limbic system also plays a vital role in the generation of

emotions and their interaction with our behaviour.

Looking to the future

It is fascinating to observe and learn about the complex ways in which

the components of the brain create and control aspects of our being.

If we can combine this knowledge with the ever-increasing technology

that permits us to see how a brain affected by Alzheimer’s disease

changes, in future we may be able to predict, treat and manage the

various symptoms associated with the disease. For now, a greater

CH

AP

TE

R 2

: A

DD

ITIO

NA

L R

EA

DIN

G

23

appreciation of the relationship between the brain and our

behaviour may help people with Alzheimer’s disease and those

around them to understand and cope with the many changes brought

about by the condition.

For details of Alzheimer’s Society services in your area, visit

alzheimers.org.uk/localinfo

For information about a wide range of dementia-related topics, visit

alzheimers.org.uk/factsheets

8

CH

AP

TE

R 2

: AD

DIT

ION

AL

RE

AD

ING

24

9

Registered charity no. 296645. A company limited by guarantee and registered

in England no. 2115499

Factsheet 456LP

Last reviewed: November 2010

Next review due: November 2012

Written and reviewed by: Dr Sebastian

Crutch at the Dementia Research

Centre, National Hospital for

Neurology and Neurosurgery

Alzheimer’s Society National

Dementia Helpline

England, Wales and Northern Ireland:

0300 222 11 22

9am–5pm Monday–Friday

10am–4pm Saturday–Sunday

alzheimers.org.uk

Alzheimer’s Society is the UK’s

leading support and research charity

for people with dementia, their

families and carers.

This publication contains information and general advice. It should not be used

as a substitute for personalised advice from a qualiied professional. Alzheimer’s

Society does not accept any liability arising from its use. We strive to ensure that

the content is accurate and up to date, but information can change over time.

Please refer to our website for the latest version and for full terms and conditions.

© Alzheimer’s Society, 2013. All rights reserved. Except for personal use, no part

of this work may be distributed, reproduced, downloaded, transmitted or stored

in any form without the written permission of Alzheimer’s Society.

CH

AP

TE

R 2

: A

DD

ITIO

NA

L R

EA

DIN

G

Dementia and Delirium Care Hospital Volunteer Training ©

Agency for Clinical Innovation 2014

25

De

lirium

Bro

chu

re

CONTACTS

Carers Resource Centres

Ph: 1800 242 636

Aged Care Information Line

Ph: 1800 500 853

National Dementia Helpline

Ph: 1800 100 500

Carers Australia

www.carersaustralia.com.au

Alzheimer’s Australia

www.alzheimers.org.au

If you have any concerns or questions

about delirium, talk to your local doctor

or ask your hospital staff.

Delirium

Delirium is a common medical problem that

is characterised by changes in mental function

and occurs more often among older people.

When delirium occurs people are confused and

may be ether very agitated or quiet and drowsy.

The onset of delirium is always sudden.

It usually only lasts for a few days but

may persist for longer periods.

It can be a serious condition.

This brochure provides information for

people who have experienced delirium and

for their family/carers.HSS011_075-02

Adapted with permission from Northern NSW Local Health District and Delirium Care Pathways, Department of Health and Aging, Canberra. 2010.

This brochure has been produced as part of the Care of Confused Hospitalised Older Persons program (CHOPS).

How can you help care for someone

with delirium?

It is reassuring for people with delirium to see

familiar people. Visit as often as you can and try

to be available to help with their care.

Encourage other family members or friends to help

as well.

Speak slowly in a clear voice when talking to

someone who has delirium. Identify both yourself

and the person by name.

Encourage and assist someone with delirium to

have adequate food and fluids.

Knowing the time of day can reduce confusion.

Remind them where they are, and what day and

time it is. Open the curtains in their room.

Visual or hearing impairment can make their

confusion worse. If someone with delirium

usually wears glasses or hearing aids, help them

to put them on.

If someone with delirium is agitated or aggressive,

do not try to restrain them. If they want to walk

around, let them, but try to make sure that they

are safe from falling and that the area is free

from hazards.

Bring personal mementos that help remind

the person of home, such as photos, their

dressing gown, radio or CD/tape player with

favourite music.

Let staff know any special personal information

that may help calm and orient someone with

delirium, such as, the names of family and friends,

hobbies, significant events etc.

DELIRIUMDELIRIUM

CHAPTER 2 : ADDITIONAL READING

Dementia and Delirium Care Hospital Volunteer Training ©

Agency for Clinical Innovation 2014

26

Who is at risk of developing delirium?

People who:

– are very sick

– have dementia

– are 70 years of age or more

– suffer from depression

– have poor eyesight

– are taking multiple medications

– are having a surgical procedure eg heart or hip surgery.

What are the symptoms of delirium?

People with delirium may:

– appear confused and forgetful

– be unable to pay attention

– be different from their normal selves

– be either very agitated or quiet and

withdrawn or sleepy

– be unsure of the time of day or where they are

– have changes to their sleeping habits, such as

staying awake at night and being drowsy

during the daytime

– feel fearful, upset, irritable, angry or sad

– see things that are not there, but that seem

very real to them

– lose control of their bladders or bowels.

How long does delirium last?

Delirium usually only lasts for a few days but

sometimes it will continue for weeks or even

months. If delirium is not resolved quickly, it

can lead to serious complications such as falls,

pressure ulcers, longer lengths of stay in hospital,

and even death.

Will delirium recur?

People who have experienced delirium do have a

higher risk of experiencing delirium again.

How is delirium treated?

Delirium is generally associated with an

underlying physical illness. However it is not

always possible to identify the cause. Staff will

do a thorough medical assessment to look for

and treat the underlying cause of the delirium.

Treatment also includes reducing the risk of

complications and lessening symptoms.

Family members/carers can provide

valuable information to the staff caring

for the person with delirium.

It is important to notify staff of any

sudden change in a person’s mental or

physical condition.

DELIRIUM

Role of family and carers

How common is delirium?

About one-fifth of older people admitted to hospital,

and close to half of the residents in aged care facilities

will experience delirium at some stage of their care.

What causes delirium?

Common causes of delirium in older people include:

– infection (including urinary tract infection

in males or females)

– multiple physical illnesses

– constipation

– dehydration/malnutrition

– severe pain

– medications, including 'over-the-counter'

medicines

– heavy alcohol consumption

– withdrawal from alcohol or medication,

particularly sleeping pills.

How does delirium start?

The symptoms happen very quickly, usually over

hours or days. A person's behaviour can also

fluctuate during the course of a single day.

Delirium is sometimes mistaken for dementia or

depression, so it is important for family/friends to

notify medical/nursing staff of any sudden change

in a person's mental state.


27

What this chapter covers •Thepresenceofdementiaprogressivelyimpactsontheperson’sabilitytocommunicate.

•Thereareanumberofwaystosupporteffectivecommunicationbetweenavolunteerandtheperson

with dementia.

•Personcentredcareputsthepersonatthecentreoftheircare.Itrespectstheuniquenessoftheperson,

their individual values and preferences.

•Gaininginformationaboutthepersonsbackgroundandpersonalpreferencescangreatlysupport

communication and person centred care.

•Communicationwithfamilycarersorotherswhoknowthepersonisessentialingatheringinformation

to support person centered care.

•Familycarersmaydiscloseinformationtoavolunteerthatisimportantforstafftoknow.

Additional reading/information 1. Alzheimer’s Australia Help sheet – Communication.

2. The Personal Profile.


1. Dementia can affect a person’s ability to communicate . True False

2. People with dementia may not be able to recognise familiar objects such

as a cup or spoon.

True False

3. People with dementia don’t have emotions and feelings. True False

4. Providing person centred care involves gaining an understanding of the

person, their background, personal preferences.

True False

5. Completion of a person profile can greatly support volunteers in their

communication with patients.

True False


CHAPTER 3: COMMUNICATION AND

PERSON CENTRED CARE

CH

AP

TE

R 3

28

Communication Help Sheet


COMMUNICATION This Help Sheet explains some of the changes in communication that occur as a result of dementia and suggests ways that families and carers can help. It also includes some personal tips on communication written by a person with dementia.

Losing the ability to communicate can be one of the most frustrating and difficult problems for people with dementia, their families and carers. As the illness progresses, a person with dementia experiences a gradual lessening of their ability to communicate. They find it more and more difficult to express themselves clearly and to understand what others say.

Some changes in communication

Each person with dementia is unique and difficulties in communicating thoughts and feelings are very individual. There are many causes of dementia, each affecting the brain in different ways.

Some changes you might notice include:

• Dificulty in inding a word. A related word might be given instead of one they cannot remember

• They may speak luently, but not make sense

• They may not be able to understand what you are saying or only be able to grasp part of it

• Writing and reading skills may also deteriorate

• They may lose the normal social conventions of conversations and interrupt or ignore a speaker, or fail to respond when spoken to

• They may have dificulty expressing emotions appropriately

Where to begin

It is important to check that hearing and eyesight are not impaired. Glasses or a hearing aid may help some people. Check that hearing aids are functioning correctly and glasses are cleaned regularly.

Remember

Communication is made up of three parts:

• 55% is body language which is the message we give out by our facial expression, posture and gestures

• 38% is the tone and pitch of our voice

• 7% is the words we use

These statistics highlight the importance of how families and carers present themselves to a person with dementia. Negative body language such as sighs and raised eyebrows can be easily picked up.

What to try

Caring attitude

People retain their feelings and emotions even though they may not understand what is being said, so it is important to always maintain their dignity and self esteem. Be flexible and always allow plenty of time for a response. Where appropriate, use touch to keep the person’s attention and to communicate feelings of warmth and affection.

Ways of talking

• Remain calm and talk in a gentle, matter of fact way

• Keep sentences short and simple, focusing on one idea at a time

• Always allow plenty of time for what you have said to be understood

• It can be helpful to use orienting names whenever you can, such as “Your son Jack”

Body language

You may need to use hand gestures and facial expressions to make yourself understood. Pointing or demonstrating can help. Touching and holding their hand may help keep their attention and show that you care. A warm smile and shared laughter can often communicate more than words can.

CARING FOR SOMEONE

WITH DEMENTIA 1

This help sheet is funded by the Australian Government under the National Dementia Support Program


CH

AP

TE

R 3

: A

DD

ITIO

NA

L R

EA

DIN

G

29





Reviewed March 2012

ABOUT

DEMENTIA

The right environment

• Try to avoid competing noises such as TV or radio

• If you stay still while talking you will be easier to follow, especially if you stay in the person’s line of vision

• Maintain regular routines to help minimise confusion and assist communication

• It is much less confusing if everyone uses the same approach. Repeating the message in exactly the same way is important for all the family and all carers

What NOT to do

• Don’t argue. It will only make the situation worse

• Don’t order the person around

• Don’t tell them what they can’t do. Instead state what they can do

• Don’t be condescending. A condescending tone of voice can be picked up, even if the words are not understood

• Don’t ask a lot of direct questions that rely on a good memory

• Don’t talk about people in front of them as if they are not there

Adapted from Understanding dificult behaviours, by Anne Robinson, Beth Spencer and Laurie White.

Tips from a person with dementia

Christine Bryden (Boden) was diagnosed with dementia at age 46, and has shared a number of her insights about ways that families and friends can help a person with dementia. Christine is also the author of a number of publications, including Who will I be

when I die?, the irst book written by an Australian with dementia.

Christine provides these tips for communicating with a person with dementia:

• Give us time to speak, wait for us to search around that untidy heap on the loor of the brain for the word we want to use. Try not to inish our sentences. Just listen, and don’t let us feel embarrassed if we lose the thread of what we say

• Don’t rush us into something because we can’t think or speak fast enough to let you know whether we agree. Try to give us time to respond – to let you know whether we really want to do it

• When you want to talk to us, think of some way to do this without questions that can alarm us or make us feel uncomfortable. If we have forgotten something special that happened recently, don’t assume it wasn’t special for us too. Just give us a gentle prompt – we may just be momentarily blank

• Don’t try too hard though to help us remember something that just happened. If it never registered we are never going to be able to recall it

• Avoid background noise if you can. If the TV is on, mute it irst

• If children are underfoot remember we will get tired very easily and ind it very hard to concentrate on talking and listening as well. Maybe one child at a time and without background noise would be best

• Maybe ear plugs for a visit to shopping centres, or other noisy places

FURTHER INFORMATION


For language assistance phone the Translating and Interpreting Service on 131 450

CARING FOR SOMEONE

WITH DEMENTIA1

CH

AP

TE

R 3

: AD

DIT

ION

AL

RE

AD

ING


PERSONAL PROFILE FOR VOLUNTEER TO COMPLETE WITH PATIENT AND/OR CARER

Patients Name:_____________________________________

Patients preferred name?_____________________________________________

Where do you live now?:_____________________________________________

Where have you lived most of your life?:________________________________

Family details: eg: spouse, partner, children, grandchildren, siblings.

Name Relationship Town they live in

Other close friends/ neighbours /carers:

Name Relationship Town they live in

Do you have a pet? Y / N

If Yes Type of Pet? _____________ Name of pet_________________________

Favourite Food:_____________________________________________________

Any special diet needs (eg diabetic, gluten free, pureed)___________________

Favorite drink: tea / coffee / Milo / milk / other :___________________________

Preferences on how drink is made: eg Milk and sugar: _____________________

__________________________________________________________________

CH

AP

TE

R 3

: A

DD

ITIO

NA

L R

EA

DIN

G


Life Experiences

War service:_________________________________________________________

Main occupation (past and/or present):____________________________________

Clubs and Associations:________________________________________________

Travel or holidays enjoyed:______________________________________________

_____________________________________________________________________

Activities/interests: (please circle) Sport: Golf / bowls / bridge / fishing / swimming / lifesaving / football / hockey / tai chi / horse riding /

cricket / horse racing / Other: please state:_____________________

Other interests:

Gardening / needlework / knitting / painting or drawing / pottery / cards / cooking /stamp collecting/ /

singing / dancing / musical instrument / other – please state:

______________________________________________________________________

Favourite type of Music:

Country / classical / opera / jazz / rock and roll / folk / pop / brass bands / other – please state:

___________________________________________________________

Favourite type of movies:

Westerns/ musicals / old movies / romances / comedy / documentaries / wildlife / sporting / drama’s /

murder mystery / other – please state:_____________________

Favourite TV Programs

Live shows / police shows / news / current affairs / comedy / documentaries /

Other – please state:______________________________________________________

Preferred Radio station: ABC / Radio National / 2EC / other:_____________________

Reading

Enjoys reading? Yes / No Able to read independently? Yes / No

Needs glasses to read? Yes / No Would like someone to read to them? Yes / No

Type of reading preferred: magazines / books / newspaper / Other – please state:

________________________________________________________________________

Other Physical considerations: (please circle)

Hearing problems / hearing aid with patient / can walk independently or alone/ uses a walking stick /

uses a walking frame / uses a walker / difficulty with communication / Other – please state:

________________________________________________________________________

Anything else you would like us to know?____________________________________

________________________________________________________________________

Volunteer completing form: _______________________________ Date ___/___/____

CH

AP

TE

R 3

: AD

DIT

ION

AL

RE

AD

ING


CHAPTER 4: ACTIVITIES FOR PATIENTS

What this chapter covers •Knowingtheperson,theirbackgroundandpastexperience,theirinterestsandhobbiesandwho

and what is important to them assists in identifying meaningful activities.

•Communicationandonetooneinteractionisanimportantpartofactivities.

•Interactingandparticipatinginactivitieswithpatientscanbeveryrewardingforvolunteers.

•Peoplewithdementiaanddeliriuminhospitalareunwellsotheirabilitytoconcentrateandengage

in activities is limited.

Additional reading/information 1. Alzheimer’s Australia Help sheet – Therapies and Communication .

2. Alzheimer’s Australia Help sheet – Activities.

3. List of activity resources.


1. The information on the patient’s personal profile can assist volunteers in

deciding on appropriate activities for the patient.

True False

2. Sitting and talking with patients is not an activity. True False

3. Distraction activities can assist with patients who may be unsettled or

agitated.

True False

4. Playing a patient’s preferred music is an activity. True False

5. Because patients in hospital are unwell, some will be sleepy and not be able

to concentrate on activities.

True False


CH

AP

TE

R 4

33

Therapies and Communication Help Sheet


THERAPIES ANDCOMMUNICATIONAPPROACHES This Help Sheet briefly explains three approaches to communicating with people with dementia – Validation Therapy, Music Therapy and Reminiscence. Many families and carers find these approaches helpful in providing support that is respectful and dignified when communication is difficult.

Communicating effectively with a person who has dementia becomes an increasing challenge as the person progressively loses their memory and their ability to organise and express their thoughts. For many, the loss of recent memory means that the past begins to merge with the present resulting in additional dificulties for family and carers.

A number of alternative communication approaches have been developed which attempt to provide the trust and support so necessary to a person’s wellbeing. Many family members and carers will be instinctively using some of them without realising their formal names.

Validation Therapy

Validation Therapy advocates that, rather than trying to bring the person with dementia back to our reality, it is more positive to enter their reality. In this way empathy is developed with the person, building trust and a sense of security. This in turn reduces anxiety. Many families and carers report increased beneits for themselves, as well as for the person with dementia, from a reduced number of conlicts and a less stressful environment.

Validation Therapy is based on the idea that once the person has experienced severe short-term memory loss and can no longer employ intellectual thinking or make sense of the present, he or she is likely to go back to the past. This may be in order to resolve uninished conlicts, relive past experiences or to retreat from the present over which they have little control. Some people will go in and out of the present.

Some family members and carers express concern that validation involves lying to the person with dementia about reality. However a more accurate description is that it avoids challenging their reality.

For instance, if a person with dementia believes that she is waiting for her children, all now middle aged, to return from school, family members and carers who use validation would not argue the point or expect their relative to have insight into their behaviour. They would not correct their beliefs. Rather, the validating approach proposes acknowledging and empathising with the feelings behind the behaviour being expressed. In this way the person’s dignity and self-esteem is maintained.

Music Therapy

Activities that involve music are another effective way of communicating with a person who has dementia. Often when other skills have gone, the person can still enjoy old familiar songs and tunes. A certain piece of music can unlock memories and feelings. It is important to be prepared to respond to the release of these feelings.

The big advantage of music is that it does not require a long attention span and it can also be a valuable trigger for reminiscing. Knowing a person’s musical likes and dislikes is vital for this to be a successful approach.

Music can be used as a formal therapy or simply for enjoyment. It can also help in the management of dificult behaviours. Music therapists have training in the use of music with people with dementia and can address some very complex behaviours.

CARING FOR SOMEONE

WITH DEMENTIA 2



CH

AP

TE

R 4

: AD

DIT

ION

AL

RE

AD

ING


34





Reviewed March 2012

ABOUT

DEMENTIA

Reminiscence

Reminiscence is a way of reviewing past events that is usually a very positive and rewarding activity. Even if the person with dementia cannot participate verbally it can still give them pleasure to be involved in relections on their past. It can also be a means of distraction if the person becomes upset.

While reviewing past events can provide a sense of peace and happiness, it can also stir up painful and sad memories. It is important to be sensitive to the person’s reactions if this happens. If their distress seems overwhelming then it is better to use another form of distraction to reduce anxiety.

This Is Your Life book

Making a chronological history of the person with dementia can help with reminiscence and provides information for people who may interact with them. It can also help carers coming in to the home or residential care facility get to know the person and their life. A This Is Your Life book is a visual diary, similar to a family photo album. It can include letters, postcards, certiicates and other memorabilia.

A large photo album with plastic protective sheets over each page will last indeinitely and can withstand a lot of use.

Each photo needs to be labeled to avoid putting the person with dementia on the spot with questions such as “Who is that?” It is best to limit the information on each page to one topic, and to have a maximum of two or three items on each page.

The following list may help in getting a book started:

• Full name and preferred name

• Place and date of birth

• Photographs and name of mother, father, brothers and sisters

• Photographs of partner and wedding day

• Photographs, names and birthdays of children and grandchildren

• Photographs of family friends, relatives and pets

• Places lived in

• Schooldays

• Occupation and war service

• Hobbies and interests

• Favourite music

• Holiday snapshots and postcards

• Letter, certiicate, diagram of family tree and short stories about speciic incidents

This book can provide a great deal of pleasure and pride for a person who may be feeling increasingly bewildered in the present.

CARING FOR SOMEONE

WITH DEMENTIA2

FURTHER INFORMATION



CH

AP

TE

R 4

: A

DD

ITIO

NA

L R

EA

DIN

G

35

Activities Help Sheet


ACTIVITIES

This Help Sheet provides information about planning and providing appropriate activities for people with dementia.

Enjoyment doesn’t require memory

Each day there are many things that provide us with purpose and pleasure. For a person with dementia, the need for a good quality of life is not diminished. However, without some assistance from family and carers, their ability to achieve purpose and pleasure is much more difficult.

Ideally, activities should:

• Compensate for lost activities

• Promote self esteem

• Maintain residual skills and not involve new learning

• Provide an opportunity for enjoyment, pleasure and social contact

• Be sensitive to the person’s cultural background

Some helpful guidelines when planning activities

Consider all that has made the person unique

This means knowing the person’s former lifestyle, work history, hobbies, recreational and social interests, travel and significant life events.

Activities can re-establish old roles

Make use of skills that have not been forgotten, such as buttering bread, washing up or watering, sweeping and raking in the garden. These are also ways in which a person with dementia can contribute to the household and feel useful. Encourage an area of responsibility no matter how small.

Activities can give relaxation and pleasure

A person with dementia may enjoy an outing even if they do not remember where they have been. What is important is that the moment is enjoyed, even though the experience may be soon forgotten.

Simple and unhurried activities that are meaningful are best

Give the time and space necessary to allow the person to do as much as possible. Focus on one thing at a time. Break down activities into simple, manageable steps. Communicate one instruction at a time.

Prepare a safe working area

People with dementia often have difficulty with visual perception and coordination. Ensure that surfaces are uncluttered with few distractions and noise. Good lighting, without glare, individual seat preferences and correct work heights are all important. Using plastic containers might help to avoid breakages.

Don’t allow activities to reinforce inadequacy or increase stress

Abilities can fluctuate from day to day. Activities can be adapted and tried another time if not successful or enjoyable.

Use times to suit the person’s best level of functioning

To ensure maximum success when carrying out activities it is best to consider the times of day when the person is at their best. For instance, sometimes walking is best done in the morning or the early afternoon. However for some people who are particularly restless later in the day, a late afternoon walk may be better.

CARING FOR SOMEONE

WITH DEMENTIA 5


CH

AP

TE

R 4

: AD

DIT

ION

AL

RE

AD

ING

36





Reviewed March 2012

ABOUT

DEMENTIA

Don’t over stimulate

Be selective with outings. Avoid crowds, constant movement and noise which many people with dementia find overwhelming.

Allow an emotional outlet

For many people, music or contact with babies, children or animals provide positive feelings. Excellent memories of past events are often kept and looking through old photos, memorabilia and books enables the recall of earlier times. The opportunity to relive treasured moments can be deeply satisfying. If reading skills have deteriorated make individual audiotapes. Locate picture books and magazines in the person’s areas of interest.

Include sensory experiences

Some sensory experiences that may be enjoyed are:

• Hand, neck and foot massage

• Hair brushing

• Smelling fresh flowers or pot pourri

• Using fragrant essential oils

• Stroking an animal or different textured materials

• A visit to a herb farm or a flower show

• Provide a rummage box that contains things that the person has been interested in

A sense of movement and rhythm is often retained longer than most abilities

Hire an exercise bike or a walking machine for rainy days. Be spectators or participants at dance classes or walk the dog together. Walkers enjoy the wider world while getting much needed exercise.

Consistency is important

It can be helpful to write out an activities care plan if different people are caring for the person. This will ensure that activities are consistent and are suited to the individual needs of a person with dementia.

Activities play a signiicant part in the dealing with changed behaviours

Knowing what helps to calm or divert a person when they are restless or distressed is very important. This can be particularly helpful for respite workers.

Don’t give up

Mistakes and failures will happen, but don’t let the person with dementia feel like a failure. Keep trying.

CARING FOR SOMEONE

WITH DEMENTIA5

FURTHER INFORMATION



CH

AP

TE

R 4

: A

DD

ITIO

NA

L R

EA

DIN

G


List of Activity Resources

1

Dementia Delirium Care with Volunteers Patient activity and distraction resource suggestions

Resource Description CD players Small portable CD players, labelled with numbers to

allow loan monitoring

Music CD’s A range of music – classical, country, jazz, blues, easy listening, war songs, hymns, Christmas carols. Op shops and donations good sources

Portable DVD players Need to be labelled and securely stored.

DVD’s A range of DVD’s including musicals, old favourites, comedy, documentaries, football and rugby matches, serene scenes such as underwater fish

¦ames Large and normal size domino’s Large and normal size cards Scrabble Backgammon All need to be able to be wiped over

Crosswords Easiest to download as A4 sheets that can be copied or photocopy pages of large print crossword books

Drawing or colouring Coloured pencils Colouring in books or templates. Templates can be downloaded and copied

Magazines and books A broad range§ ¦ardening, ¦¨lf, Cricket, fishing knitting, flowers, history, geography, pets. These can be sourced from donations, op shops and garage sales. A continuing source is needed as often can only be used once.

Laminated A4 pictures These are useful to generate conversation once you know the person interest. Old o© ª« calendars are a good source. A range of topics such a¬§ Animals, flowers, gardens, scenery, sport etc. The benefit of these is that they can be wiped over and reused.

Rummage or Distraction Items

Rummag ®andbags or boxes ¯ women

Source from op shops or donations. Need to be vinyl or material that can be wiped over for infection control. Fill with different textured materials and items. E.g. small purse, scarfs, bubble wrap, soft material, old keys, squeeze balls

Rummage tool Boxes ¯ Men Small plastic box filled with large plastic bolts and screws that can be put together, short pieces of tubing, squeeze balls, different textures items

Men’s fiddle box These can be purchased readymade or ask the local wood working group if they would make one. They are coloured wooden boxes with lots of latches and locks to fiddle with

Fiddle rugs, aprons or cushions.

Fiddle aprons can be purchased. ®¨°ever more innovative items are handmade. Local knitters and craft groups or volunteers themselves are happy to

CH

AP

TE

R 4

: AD

DIT

ION

AL

RE

AD

ING


make them. They involve having different textured materials and fiddle items that can be sown on. They all need to be washable for infection control

Washing basket A small washing basket filled with items such as handtowels, pillow cases, face washer etc that can be folded

Oxygen Tubing Can be taped and bandaged over existing IV cannula as a distraction and an alternative to pull at

Other items

±nitted or crocket rugs Allows a more homely feel for the bed. They need to be washable

±nitted or soft animals Patients with more advanced dementia may find comfort with these

A doll These can also be appropriate for some patients with more advanced dementia

Old Photos’ or other memorabilia

This assists with reminiscing

Magnifying sheets To assist patients who may not have their glasses in reading things

A small whiteboard and whiteboard marker

This can support visual prompts for patients with poor memory and communication

Moisturising cream To assist with gentle hand or foot massage

CH

AP

TE

R 4

: A

DD

ITIO

NA

L R

EA

DIN

G


What this chapter covers •Changedbehaviourscancommonlyoccurinpatientswithdementiaanddeliriuminhospital

•Therearemanyreasonsortriggersforchangedbehaviours.

•Gaininganunderstandingofthepersonand“puttingyourselfintheirshoes”cangreatlyassistin

understanding the triggers and supporting patients.

•Personproileinformationcangreatlyassistvolunteersinsupportingpatientswhoexperiencechanged

behaviours.

•Thereareanumberofpracticalwaysvolunteerscanassistinsettlingandcalmingpatientswhomay

have changed behaviours.

•Itisimportanttoknowandunderstandwhattodointheeventthatyoudofeelunsafewithapatient.

Additional reading/information 1. Alzheimer’s Australia Help sheet – Changed Behaviours.

2. Alzheimer’s Society UK. Unusual Behaviour Fact Sheet.


1. Onset or change in behaviours can be common in patients with dementia

and delirium.

True False

2. Wandering and agitation are not behaviours. True False

3. There can be many causes or triggers for behaviours. True False

4. Pain and fear are not causes for changed behaviour. True False

5.Gaininganunderstandingofthepersonandtryingtounderstandwhatthey might be experiencing are ways volunteers can support patients.

True False

6. If a volunteer feels unsafe, they should stay calm, leave the room and report what

has occurred to staff.

True False


CHAPTER 5: UNDERSTANDING

BEHAVIOURS WHICH CAN OCCUR

IN PATIENTS WITH DEMENTIA AND

DELIRIUM

CH

AP

TE

R 5

40

Changed Behaviour Help Sheet

CHANGED BEHAVIOURS

AND DEMENTIA


CHANGEDBEHAVIOURSThis Help Sheet looks at some of the common behaviour changes that may occur when a person has dementia. Reasons for the changes and some general guidelines for coping with them are discussed.

Changes in the behaviour of a person with dementia are very common. This may place enormous stress on families and carers. It can be particularly upsetting when someone previously gentle and loving behaves in a strange or aggressive way.

Why does behaviour change?

There are many reasons why a person’s behaviour may be changing. Dementia is a result of changes that take place in the brain and affects the person’s memory, mood and behaviour. Sometimes the behaviour may be related to these changes taking place in the brain. In other instances, there may be changes occurring in the person’s environment, their health or medication that trigger the behaviour. Perhaps an activity, such as taking a bath, is too difficult. Or the person may not be feeling physically well. Dementia affects people in different ways. Understanding why someone is behaving in a particular way may help you with some ideas about how to cope.

Where to begin

Always discuss concerns about behaviour changes with the doctor, who will be able to check whether there is a physical illness or discomfort present and provide some advice. The doctor will be able to advise if there is an underlying psychiatric illness.

Coping

Coping with changed behaviours can be very difficult, and is often a matter of trial and error. Always remember that the behaviour is not deliberate. Anger and aggression are often directed against family members and carers because they are closest. The behaviour is out of the person’s control and they may be quite frightened by it. They need reassurance, even though it may not appear that way.

What to try

• A calm, unstressed environment in which the person with dementia follows a familiar routine can help to avoid some dificult behaviours

• Try to keep the environment familiar. People with dementia can become upset if they ind themselves

in a strange situation or among a group of unfamiliar people where they feel confused and unable to cope. The frustration caused by being unable to meet other people’s expectations may be enough to trigger a change in behaviour

• If a behaviour becomes dificult, it is best not to attempt any form of physical contact such as restraining, leading them away or approaching from behind. It may be better to leave them alone until they have recovered, or call a friend or neighbour for support

• Try not to take it personally

• Try not to use a raised voice

• Avoid punishment. The person may not remember the event and is therefore not able to learn from it

• Speak slowly, in a calm and reassuring voice

• Try not to become provoked or drawn into an argument

Aggression

This can be physical, such as hitting out, or verbal such as using abusive language. Aggressive behaviour is usually an expression of anger, fear or frustration.

What to try

• The aggression may be due to frustration. For example, locking the door may prevent wandering but may result in increased frustration

• Activity and exercise may help prevent some outbursts

• Approaching the person slowly and in full view may help. Explain what is going to happen in short, clear statements such as “I’m going to help you take your coat off”. This may avoid the feeling of being attacked and becoming aggressive as a self-defence response

• Check whether the aggressive behaviour is about getting what the person wants. If so, trying to anticipate their needs may help

1



CH

AP

TE

R 5

: A

DD

ITIO

NA

L R

EA

DIN

G

41





Reviewed March 2012

ABOUT

DEMENTIA

Catastrophic reactions

Some people with dementia over-react to a trivial setback or a minor criticism. This might involve them screaming, shouting, making unreasonable accusations, becoming very agitated or stubborn, or crying or laughing uncontrollably or inappropriately. Alternatively, the person might become withdrawn. This tendency to over-react is part of the disease and is called a catastrophic reaction.

Sometimes a catastrophic reaction is the first indication of the dementia. It may be a passing phase, disappearing as the condition progresses, or it may go on for some time.

Catastrophic behaviour may be a result of:

• Stress caused by excessive demands of a situation

• Frustration caused by misinterpreted messages

• Another underlying illness

This behaviour can appear very quickly and can make family and carers feel frightened. However, trying to figure out what triggers catastrophic behaviour can sometimes mean that it can be avoided. Keeping a diary may help to identify the circumstances under which they occur. If this isn’t possible, you can find ways of dealing with the behaviour quickly and effectively using some of the guidelines listed earlier.

Hoarding

People with dementia may often appear driven to search for something that they believe is missing, and to hoard things for safekeeping.

Hoarding behaviours may be caused by:

• Isolation. When a person with dementia is left alone or feels neglected, they may focus completely on themselves. The need to hoard is a common response

• Memories of the past. Events in the present can trigger memories of the past, such as living with brothers and sisters who took their things, or living through the depression or a war with a young family to feed

• Loss. People with dementia continually lose parts of their lives. Losing friends, family, a meaningful role in life, an income and a reliable memory can increase a person’s need to hoard

• Fear. A fear of being robbed is another common experience. The person may hide something precious, forget where it has been hidden, and then blame someone for stealing it

What to try

• Learn the person’s usual hiding places and check there irst for missing items

• Provide a drawer full of odds and ends for the person to sort out as this can satisfy the need to be busy

• Make sure the person can ind their way about, as an inability to recognise the environment may be adding to the problem of hoarding

Repetitive behaviour

People with dementia may say or ask things over and over. They may also become very clinging and shadow you, even following you to the toilet. These behaviours can be very upsetting and irritating.

What to try

• If an explanation doesn’t help, distraction sometimes works. A walk, food or favourite activity might help

• It may help to acknowledge the feeling expressed. For example “What am I doing today?” may mean that the person is feeling lost and uncertain. A response to this feeling might help

• Do not remind the person that they have already asked the question

• Repetitive movements may be reduced by giving the person something else to do with their hands, such as a soft ball to squeeze or clothes to fold

Based on Understanding and dealing with challenging behaviour, Alzheimer Scotland – Action on Dementia

Discuss with the doctor your concerns about behaviour changes, and their impact on you.

The Dementia Behaviour Management Advisory Service (DBMAS) is a national telephone advisory service for families, carers and care workers who are concerned about the behaviours of people with dementia. The service provides confidential advice, assessment, intervention, education and specialised support 24 hours a day, 7 days a week and can be contacted on 1800 699 799.

CHANGED BEHAVIOURS

AND DEMENTIA1

FURTHER INFORMATION



CH

AP

TE

R 5

: AD

DIT

ION

AL

RE

AD

ING

42

Unusal Behaviour Help Sheet

alzheimers.org.uk

Unusual behaviour

As dementia develops, it can cause behaviour changes that can

be confusing, irritating or dificult for others to deal with, leaving

carers, partners and family members feeling stressed, irritable

or helpless. By learning to understand the meaning behind the

actions, it can be easier to stay calm and deal effectively with

the challenges that arise. This factsheet outlines some typical

sorts of unusual behaviour in people with dementia and explains

some common causes.

Each person is an individual, with their own preferences and character

traits. However, certain forms of behaviour are particularly common in

people with dementia. If the person you are caring for has dificulty

expressing him or herself in words, the unusual behaviour may

become more extreme. By working out what each behaviour means,

and inding ways to overcome the problem, the situation can become

more manageable.

Common types of unusual behaviour

Repetitive behaviour

People with dementia often carry out the same activity, make

the same gesture, or ask the same question repeatedly. Medical

professionals sometimes call this ‘perseveration’. This repetition may

be because the person doesn’t remember having done it previously,

but it can also be for other reasons, such as boredom.

It is not unusual for a person with dementia to go through the

motions of the activity they may previously have carried out at work.

CH

AP

TE

R 5

: A

DD

ITIO

NA

L R

EA

DIN

G

43

This can indicate a need to be occupied and to feel there is a

purpose and structure to their life. Speciic types of repetitive

behaviour may include:

•Asking the same question over and over again – As well as

memory loss, this can be due to the person’s feelings of insecurity

or anxiety about their ability to cope. Try to be tactful and patient,

and encourage them to ind the answer for themselves. For example,

if they keep asking the time, and you know they are able to

understand the clock, suggest that they look at the clock themselves.

It may help if you to move the clock to a position that is more visible.

People with dementia may become anxious about future events

such as a visitor arriving, which can lead to repeated questioning.

It may help if you don’t mention the event until just before it takes

place.

•Repetitive phrases or movements – This can be due to noisy or

stressful surroundings, or boredom. Encourage the person to do

something active, such as going for a walk. It can also be a sign of

discomfort, so check that the person isn’t too hot or cold, hungry,

thirsty or constipated. Contact the GP if there is any possibility that

the person may be ill or in pain, or experiencing a side-effect of

medication.

•Repetitive actions – Actions such as repeatedly packing and

unpacking a bag, or rearranging the chairs in a room, may relate to

a former activity such as travelling or entertaining friends. If so, this

may serve as a basis for conversation. Alternatively, it could signify

boredom or a need for more contact with people.

•Repeatedly asking to go home – This may take place in residential

care, or when the person is already at home. It can be a sign of

anxiety, insecurity, fear or depression. The concept of ‘home’ might

evoke memories of a time or place where the person felt comfortable

or safe, or of a home, family and friends that no longer exist. If the

person doesn’t recognise their present environment as ‘home’,

then it isn’t home for them. Try to understand and acknowledge the

person’s feelings and reassure them that they are safe and loved.

CH

AP

TE

R 5

: AD

DIT

ION

AL

RE

AD

ING

44

•Multiple phone calls – Some people with dementia phone their

loved ones over and over again – particularly in the middle of the

night. This can be very frustrating and distressing. The person with

dementia may forget that they have already called, or may be

insecure or anxious. If you are receiving repeated calls, it may help to

get a phone with a number recognition display or an answerphone

so you can decide whether you want to answer, and switch mobiles

and ringers off at night. You may feel guilty about not answering

every call, but it’s important to look after yourself and get some rest.

Restlessness

Some people with dementia experience general restlessness. This can

be a sign of hunger, thirst, constipation or pain, or the person may be

ill or suffering from the side-effects of medication. Other possibilities

are boredom, anger, distress or anxiety, stress due to noisy or busy

surroundings, or lack of exercise. It may also be due to changes that

have taken place in the brain. If the person seems upset, try to ind the

reason, give them some reassurance, then try to distract them with an

interesting activity, or by involving them in some form of exercise.

•Pacing up and down – Pacing may indicate that the person wants

to use the toilet but is unable to tell you. Try asking the person

whether they need to use the toilet, or lead them towards it. If they

are adamant that they want to pace, try to ind somewhere they can

walk safely. If a person has always been active and walked regularly,

they may be feeling frustrated and want some fresh air. Help to

choose comfortable clothes and shoes, offer drinks and snacks,

check their feet regularly for redness, swellings or blisters, and try to

persuade them to rest from time to time.

•Fidgeting – Someone with dementia may idget constantly. As

with pacing, try to distract their attention and offer reassurance.

Try giving the person something to occupy their hands, such as a

soft toy or worry beads, or provide a ‘rummage’ box containing

interesting objects.

CH

AP

TE

R 5

: A

DD

ITIO

NA

L R

EA

DIN

G

45

Shouting and screaming

The person may continually call out for someone, shout the same

word, or scream or wail over and over again.

•They could be in pain or ill, experiencing dificulties with visual

perception or hallucinations, or the behaviour could be a result of

brain damage. In these cases, talk to the GP.

•A person with dementia may feel lonely or distressed, if their short

term memory is damaged they may not remember that you are in

the next room and believe they are alone. They may feel anxious

about their failing memory, bored, or stressed by too much noise

and bustle.

•If the person shouts out at night, a nightlight in the bedroom may

be reassuring.

•Consider how the room looks in the dark. Are there shadows or

shapes that cannot be seen when the light is on but that could be

misinterpreted and look frightening in the dark?

•If they are calling for someone from their past, try talking to them

about this period in their life and respond to the feelings the person

is showing. Avoid harsh facts that may cause distress – if the person

they are asking for has died, they may not remember this fact and

will feel they are hearing it for the irst time.

Lack of inhibition

The person may behave in a way that other people ind embarrassing

because of their failing memory and general confusion. In a few cases,

this may be due to speciic damage to the brain. Try to react calmly.

•Some people with dementia may undress in public, having

forgotten when and where it is appropriate to remove their

clothes. If this happens, take the person somewhere private, and

check whether they are too hot or are uncomfortable or want to use

the toilet.

CH

AP

TE

R 5

: AD

DIT

ION

AL

RE

AD

ING

46

•Stroking or exposing genitals in public, or apparently inappropriate

sexual behaviour, may be a result of the physical damage to the part

of the brain that allows us to recognise acceptable social behaviours.

If this happens, discourage the person tactfully and try to distract

their attention. It is important to remember that having a dementia

does not mean a person no longer has physical or sexual needs –

simply that inhibitions and social skills may not be functioning. If

such behaviour is frequent or persistent, consult the GP.

•Some actions, such as lifting a skirt or iddling with lies, may not be

related to sex at all – it may simply be a sign that the person wants

to use the toilet.

•If the person behaves rudely – for example, by insulting people

or swearing or spitting – don’t attempt to argue or correct the

behaviour. Try to distract their attention, and explain to other people

later that the behaviour is due to dementia and is not directed at

them personally.

Night-time waking

Many people with dementia are restless at night and ind it dificult

to sleep. Older people often need less sleep than younger people in

any case. Dementia can affect people’s body clocks so that they may

get up in the night, get dressed or even go outside. This can be very

worrying – and exhausting – for carers.

•Make sure the person has enough exercise during the day and that

they use the toilet before bed.

•Try a walk before bedtime, a warm milky drink and soothing

company before they fall asleep.

•If the person wakes up, gently remind them that it is night-time.

•During the light summer months it can feel like daytime even late

at night or very early in the morning, so put a clock that shows

whether it is am or pm next to the bed and consider darker curtains

or blackout blinds.

CH

AP

TE

R 5

: A

DD

ITIO

NA

L R

EA

DIN

G

47

Trailing and checking

Living with dementia makes many people feel extremely insecure and

anxious. This can result in the person constantly following their carers

or loved ones around, or calling out to check where they are. A few

moments may seem like hours to a person with dementia, and they

may only feel safe if other people are nearby.

•This behaviour can be very dificult to cope with, but try not to speak

sharply.

•If you are busy, give the person something absorbing to do –

perhaps distraction through a pet, task or activity, or you can hum or

sing, or put the radio on.

•Make sure you also ind some time for yourself.

Hiding and losing things

People with dementia sometimes hide things and then forget where

they are – or forget that they have hidden them at all. The wish to

hide things may be due to feelings of insecurity and a desire to hold

on to what little the person still has.

•However impatient you feel, try to be reassuring.

•Don’t leave important documents lying around, and make sure you

have a spare set of keys.

•Try and ind out the person’s hiding places so that you can tactfully

help ind ‘missing’ items.

•If the person hides food, check hiding places regularly, and discreetly

dispose of any perishable items.

Suspicion

Some people with dementia can become suspicious. If they have

mislaid an object they may accuse someone of stealing it, or they

may imagine that a friendly neighbour is plotting against them. These

CH

AP

TE

R 5

: AD

DIT

ION

AL

RE

AD

ING

48

ideas may be due to failing memory, an inability to recognise people,

and the need to make sense of what is happening around them.

•If this happens, state calmly what you know to be true, if

appropriate, and then reassure and distract the person.

•Try to remember that although the person’s interpretation may be

wrong, the way the person feels is real.

•Explain to others that they should not take unfounded accusations

seriously.

•Don’t automatically dismiss the person’s suspicions if there is any

possibility that they may be true.

Sleeplessness and ‘sundowning’

Many people with dementia, especially in the middle stages,

experience periods of increased confusion at dusk, with their

disorientation continuing throughout the night. These periods of

what is known as ‘sundowning’ usually diminish as the dementia

progresses.

Sundowning may be caused by:

•mental and physical tiredness at the end of the day

• reduced lighting and an increase in shadows

•less need for sleep, common among older adults

•an upset ‘body clock’ with the body mixing up day and night.

See sections on ‘Restlessness’ and ‘Night-time waking’ for suggestions

on how to deal with the effects of sundowning.

Tips: Coping with unusual behaviour

•Try to remember that the person you are caring for is not being

deliberately dificult, their sense of reality may be very different to

CH

AP

TE

R 5

: A

DD

ITIO

NA

L R

EA

DIN

G

49

yours but very real to them. Dementia can affect a person’s ability to

use logic and reason so things that may seem obvious to you might

appear to be very different for the person with dementia.

•Ask yourself whether the behaviour is really a problem. If the

behaviour is linked to a particular activity such as washing or

dressing, ask yourself if this task really needs to be done right now or

if you could leave it for a while until the person has calmed down.

•Try to put yourself in the person’s situation. Imagine how they might

be feeling and what they might be trying to express.

•Offer as much reassurance as you can.

•Remember that all behaviour is a means of communication. If you

can establish what the person is trying to communicate, you will

resolve the problem much more quickly.

•Distract the person with calming activities such as a hand massage,

stroking a pet, a drive in the country or by playing their favourite

music.

•Try to make sure that you have support for yourself and breaks when

you need them.

•Some people ind unusual behaviours, particularly a repetitive

behaviour, very irritating. If you feel you can’t contain your irritation,

make an excuse to leave the room for a while.

•If you ind the person’s behaviour really dificult to deal with, ask

for advice from professionals or other carers before you become too

stressed. Medication may sometimes be used for these behaviours,

but this should be monitored and reviewed very carefully. Ask about

the possible side-effects of any drugs so that if they appear you do

not automatically assume that the dementia has become worse.

•Remember that it is possible to be the cause of the behaviour

through a lack of understanding of what the person is trying to

communicate. Try stepping away from the situation, look at the

person’s body language and try to understand what they might be

feeling at that time. Give the person space to calm down and offer

reassurance.

CH

AP

TE

R 5

: AD

DIT

ION

AL

RE

AD

ING

50

For details of Alzheimer’s Society services in your area, visit

alzheimers.org.uk/localinfo

For information about a wide range of dementia-related topics, visit

alzheimers.org.uk/factsheets

Registered charity no. 296645. A company limited by guarantee and registered

in England no. 2115499

Factsheet 525LP

Last updated: November 2010

Last reviewed: November 2010

Reviewed by: Cathy Baldwin,

Programme Delivery Manager,

Knowledge and Learning, Alzheimer’s

Society

Alzheimer’s Society would like to

thank Janet Keane of the Department

of Psychiatry at Oxford University for

her help in preparing this factsheet.

This factsheet has also been reviewed

by people affected by dementia.

A list of sources is available on

request.

Alzheimer’s Society National

Dementia Helpline

England, Wales and Northern Ireland:

0300 222 11 22

9am–5pm Monday–Friday

10am–4pm Saturday–Sunday

alzheimers.org.uk

Alzheimer’s Society is the UK’s

leading support and research charity

for people with dementia, their

families and carers.

This publication contains information and general advice. It should not be used

as a substitute for personalised advice from a qualiied professional. Alzheimer’s

Society does not accept any liability arising from its use. We strive to ensure that

the content is accurate and up to date, but information can change over time.

Please refer to our website for the latest version and for full terms and conditions.

© Alzheimer’s Society, 2013. All rights reserved. Except for personal use, no part

of this work may be distributed, reproduced, downloaded, transmitted or stored

in any form without the written permission of Alzheimer’s Society.

CH

AP

TE

R 5

: A

DD

ITIO

NA

L R

EA

DIN

G


What this chapter covers •Theprocessforcheckingthepatientsname,dietorderandluidsonthemenu.

•Theimportanceofsocialengagement,communicationandminimisingdistractions.

•Safetyandpositioningconsiderationsforassistingpatientswithmeals.

•Identifyingandreportinganyproblemswhenassistingwithfeeding.

•Therangeofdifferentstandardisedfoodandluidtextures.

•Communicatingfoodandluidamountsconsumedbypatientstostaff.

Additional reading/information 1. Australian Food Standards.

2. Alzheimer’s Australia Nutrition Help Sheet.

3. Tips for caring for a patient with swallowing difficulties.

4. Standard Fluid amounts.


1. Patients with dementia and delirium are at risk of become dehydrated

when in hospital.

True False

2. Coughing, gurgly voice, food residue left in the mouth are not signs of

swallowing difficulties.

True False

3. The 3 types of texture modified fluids are: mildly thick, moderately thick

and extremely thick.

True False

4. It is not important for the volunteer to check the patients menu to ensure

it is the correct meal.

True False

5.Gaininganunderstandingofthepersonandtryingtounderstandwhatthey might be experiencing are ways volunteers can support patients.

True False

6. It is safe for a volunteer to feed a patient when they sleepy or drowsy. True False


CHAPTER 6: ASSISTING PATIENTS WITH EATING AND DRINKING

CH

AP

TE

R 6

52

Au

stra

lian

Fo

od

Sta

nd

ard

sAustralian Standards for Texture

Modified Foods and Fluids

23342

Novartis Consumer Health Australasia Pty. Ltd. ABN 46 004 535 513 Australia 327-333 Police Road, Eastern Building, Mulgrave VIC 3170

For further information, please call 1800 671 628 (Australia) or 0800 607 662 (New Zealand). http://www.novartisnutrition.com

Mildly ThickLevel 150

Fluid runs freely off the spoon but leaves a mild coating on the spoon

Moderately ThickLevel 400

Fluid slowly drips in dollops off the end of the spoon

Extremely Thick Level 900

Fluid sits on the spoon and does not flow off it

Fluid

Texture A Soft

Food may be naturally soft or may be cooked or cut to alter its texture

Texture B Minced and Moist

Food is soft, moist and easily mashed with a fork; lumps are smooth and rounded

Texture C Smooth Pureed

Food is smooth, moist and lump free; may have a grainy quality

Food

The provision of thickened fluids and texture modified foods is a routine part of the assessment and management of feeding and swallowing difficulties (dysphagia).

If you need assistance with the level of fluid and food texture modification required, contact your Speech Pathologist.

To find a Speech Pathologist, go to

www.speechpathologyaustralia.org.au.

If you require support to determine whether a textured modified diet is meeting nutrition and hydration needs, contact your dietitian.

To find an Accredited Practising Dietitian (APD), go to

www.daa.asn.au.

Please contact Novartis on 1800 671 628 or visit www.novartisnutrition.com.au for further information or for copies of this poster.

This poster is proudly supported by

Novartis Medical Nutrition as part of the development

of the Australian Standards.

Ch

ap

ter 6

: Ad

ditio

na

l Re

ad

ing


53

Nutrition Help Sheet


NUTRITION

This Help Sheet discusses the importance of good nutrition, and provides some practical ways that families and carers can ensure that a person with dementia is well nourished.

Good nutrition is important

The type of food we eat affects our health and our quality of life. Poorly nourished people get sick more often and recover from injury and illness more slowly. Poor nutrition is a major health problem for many older people.

For people with dementia, maintaining good nutrition presents extra challenges. A person with dementia may:

• Experience a loss of appetite

• Develop an insatiable appetite or a craving for sweets

• Forget to eat and drink

• Forget how to chew or swallow

• Experience a dry mouth, or mouth discomfort

• Be unable to recognise the food and drink they are given

Daily nutritional balance

The nutritional requirements of someone with dementia will be similar to other people of their age. However some people with dementia experience increased physical activity such as pacing, which means they will need larger amounts of food to prevent them from losing weight.

Dietary guidelines for older Australians recommend:

• Enjoying a wide variety of nutritious foods

• Eating at least three meals every day

• Drinking plenty of water

• Eating plenty of vegetables (including legumes) and fruit

• Eating plenty of cereals, bread and pastas

• Eating a diet low in saturated fats

• Choosing foods low in salt and using salt sparingly

• Including foods high in calcium

• Using added sugars in moderation

Some common problems

Some people with dementia may forget to eat.

What to try

• An alarm clock, or a phone call, may be a useful reminder at mealtimes

• Snacks that are easy to eat and don’t need to be refrigerated can be left out where they can be easily seen

Some people with dementia can’t or won’t prepare meals for themselves. This can be particularly difficult if they are living alone.

What to try

• Meals should be shared social occasions whenever possible

• Delivered meals such as meals-on-wheels. However these may not provide all of a person’s daily nutritional needs or may not be what the person is used to eating

• Home support to assist with meal preparation, serving and to discretely prompt with eating

• Pre-prepared meals from the supermarket

• Family and friends helping to prepare meals and or eating together

• Preparing large quantities of food, then freezing into meal size amounts

• Home delivered ready-to-eat food from restaurants or fast food outlets

• Eating out. However check first that the person with dementia will be comfortable with the venue and food

• Stocking up on healthy snacks such as yoghurt, cheese or dried fruit that do not need preparation or cooking

CARING FOR SOMEONE

WITH DEMENTIA 13


CH

AP

TE

R 6

: AD

DIT

ION

AL

RE

AD

ING

54





Reviewed March 2012

ABOUT

DEMENTIA

Alcohol may stimulate the appetite and add to the enjoyment of a meal. However, too much alcohol can replace food and people can run the risk of becoming malnourished. If a person with dementia is a heavy drinker it may be difficult to change their drinking habits.

What to try

• Make sure that they are well nourished

• Discourage drinking on an empty stomach

• Offer drinks other than alcohol

• Water alcohol down

Finger foods

All food should be able to be eaten with dignity. If a person with dementia is having difficulty with cutlery, finger foods can be a nutritious and easy alternative.

Finger foods are simply foods prepared so that they can be eaten with the fingers. This enables people who would otherwise lose this level of independence to feed themselves.

What to try

• Prepare a plate of nutritious and attractive food that can be picked up in the fingers

• Make sure that the food is accessible. Put it on a flat plate with no pattern so that the food can be seen clearly. Make sure the plate is in comfortable reaching distance

• Don’t use complicated table settings and avoid lots of different cutlery, crockery, glasses, foods and drinks together

• Serve only one plate of food at a time

• Impairment to taste and smell senses can reduce appetite. The preparation of tasty, strongly flavoured and aromatic food may help

• Allow time for the memory to respond

• It may be necessary initially to help fingers to convey the food from the plate to the mouth

• It can help to eat together so that the person with dementia can copy you

• Types of foods served need to take the culture and past eating habits of the person into consideration

Eating in the later stages of dementia

It is common for people in the later stages of dementia to lose a considerable amount of weight. People may forget how to eat or drink, or may not recognise the food they are given. Some people become unable to swallow properly. Providing nutrition supplements may need to be considered. If a person has swallowing difficulties, or is not consuming food or drink over a significant period of time and their health is affected, nutrition supplements may be considered for consumption other than by mouth.

Based on:

Finger foods for independence; For people with Alzheimer’s disease and other eating difficulties, by Lois Newton and Dr Alan Stewart, and Reduce the risk: A common sense guide to preventing poor nutrition in older people, by Carolyn Bunney and Rudi Bartl

Who can help?

A dietician or doctor can advise you about good nutrition. Your local hospital, community health service, Commonwealth Respite and Carelink Centre, or your doctor can put you in touch with a dietician.

Commonwealth Respite and Carelink Centres around Australia provide information about the range of community care programs and services available to help people stay in their own homes. Visit commcarelink.health.gov.au or call 1800 052 222

The Dementia Behaviour Management Advisory Service (DBMAS) is a national telephone advisory service for families, carers and care workers who are concerned about the behaviours of people with dementia. The service provides confidential advice, assessment, intervention, education and specialised support 24 hours a day, 7 days a week and can be contacted on 1800 699 799.

CARING FOR SOMEONE

WITH DEMENTIA13

FURTHER INFORMATION



CH

AP

TE

R 6

: A

DD

ITIO

NA

L R

EA

DIN

G


Tips for Caring for a Person with Swallowing Dificulties

Tips when caring for a patient with swallowing difficulties

1. Is the patient alert and able to concentrate²

2. Is the posture of the patient – upright and chin tucked as below right²

3. Do they have the correct menu to fill and the correct

meal tray² Check the menu and tray ticket for the patients name and check that the diet order is correct.

4. Are they getting adequate fluid² Most people who aren’t on a fluid restriction require 1800³2000ml /day ´µ³8 cups includes tea, coffee, fruit juice, milk and wate¶·

Fluid for people with dysphagia may be eithe¶¸ ¹· Un modified ´regular fluº»¼· ½· or Thickened¸

Mildly thick ´¾¿0· Àectar like or Moderately thºÁÂ ´ÃÄ0· honey like or

Extremely thick ´ÅÄ0· Æudding like

5. Do they need aids or utensils to assist in eating their meaÇ²

6. Ensure that they have good mouth care – ¹· Mouth is clear after meals ½· Mouth care takes place with rinsing and cleaning the mouth and teeth. Á· Adequate hydration is also helpful. 7. Record and report – ¹· Poor oral intake. Èood nutrition and good fluid intake assists the

body to recuperate. ½· Body weight.

CH

AP

TE

R 6

: AD

DIT

ION

AL

RE

AD

ING


SourcÉÊ Bega Valley Dietitians. May 2014

Type of Fluid/container and standard amount

White ceramic cup Ë 180 mls

PapeÌ ÍÎÏ Ë 200 mls

Thermal tray mugs for hot drinks and clear soup Ë 200mls

Fruit juice in portion control contaiÐÑÌÒ ÓÔÑÌÌÕÖ Ë 110mls

Thickened fruit juicÑ Ó×lavour CreationsÖ Ë 185 mls

Øelly in portion control containers Ë 120mls

Soup in portion control containers Ë 200mls

Other measures 1 teasÏÙÙÐ Ë 5ml 1 soup sÏÙÙÐ Ë 15ml 1 dessert spoon Ë Ú5ml

Standard Fluid Amounts for Volunteer/staff Fluid Balance Chart Documentation

Standard Fluid Amounts

CH

AP

TE

R 6

: A

DD

ITIO

NA

L R

EA

DIN

G


What this chapter covers •Encouragingregularwalkingisbeneicialformanypatients.

•Termsusedtodescribepatientswalkingability.

•Thedifferentwalkingaidsthatavolunteermayseeapatient’susing.

•Howtopromptpatientstostand.

•Safetywhenwalkingwithpatients.

•Whattodoifapatientbecomesunsteady.

•Whattodoifyouindapatientwhohasfallen.

Additional reading/informationNil


1. Walking frames and walking sticks are the most common types of walking

aids volunteers will be involved with.

True False

2. Volunteers can only walk with patients who are independent or require

supervision.

True False

3. A volunteer can prompt or remind a patient about the right way to get out

of a chair but not physically assist.

True False

4. Encouraging patients to walk regularly when it is safe for the volunteer to

do so is an important volunteer role.

True False

5. If a patient has fallen, a volunteer can help them get up. True False

6. Volunteers should always check with staff if they are unsure about anything. True False


CHAPTER 7: SAFE WALKING WITH PATIENTS

CH

AP

TE

R 7


Congratulations! You have now completed the Dementia & Delirium Care Hospital Volunteer Training DVD.

Please complete the post education care confidence questionnaire and the training evaluation form.

Return the completed post education care confidence questionnaire, the evaluation form and the pre

education care confidence questionnaire to your volunteer coordinator or person responsible for your

training when you return the DVD



1 2 3 4 5

Please answer the following questions, by circling the number that best reflects your response.

1. How confident are you that you understand what dementia is?


1 2 3 4 5

2. How comfortable do you feel about the idea of spending time with a person with dementia?


1 2 3 4 5

3. Sometimes, when a person with dementia becomes stressed or anxious, they can become upset, angry or aggressive. How confident would you feel interacting with someone with dementia who demonstrated these behaviours?


1 2 3 4 5

4. How confident are you that you understand what delirium is?


1 2 3 4 5


Very unsure Moderately Confident Very Confident

1 2 3 4 5

6.Sometimes, when a person with a delirium becomes stressed or anxious, they can become upset, angry or aggressive. How confident would you feel interacting with someone with dementia who demonstrated these behaviours?


1 2 3 4 5


POST EDUCATION QUESTIONS

PO

ST

ED

UC

AT

ION

QU

ES

TIO

NS



Your feedback is seen as important. Please circle on the scale of 1-10 how helpful each session of the training program was to you:

1 = least helpful 10 = extremely helpful

Chapter 1: The Volunteer Role

1 2 3 4 5 6 7 8 9 10

Chapter 2: Dementia and Delirium

1 2 3 4 5 6 7 8 9 10

Chapter 3: Communication and person centred care

1 2 3 4 5 6 7 8 9 10

Chapter 4: Activities for patients

1 2 3 4 5 6 7 8 9 10

Chapter 5: Understanding behaviours in dementia and delirium

1 2 3 4 5 6 7 8 9 10

Chapter 6: Assisting patients with eating and drinking

1 2 3 4 5 6 7 8 9 10

Chapter 7: Safe walking with patients

1 2 3 4 5 6 7 8 9 10

DV

D E

VA

LU

AT

ION

DEMENTIA & DELIRIUM CARE HOSPITAL

VOLUNTEER TRAINING DVD EVALUATION


Please circle how you found the training program handouts and resources.

Not useful A little useful Moderately useful Very useful

What was the best thing about the training program?

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

What was the worst thing about the training program?

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

What could have made the training program better?

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

Thank you for taking the time to complete this feedback.

DV

D E

VA

LU

AT

ION


Chapter 1 Correct

Answer

1. The types of patients volunteers will be supporting include those who memory and thinking

problems.

True

2. The volunteer role provides similar support to that of a family carer. True

3. Reading and signing the code of conduct is a requirement for all health service staff and

volunteers.

True

4. If a referral form has not been completed the volunteer can still provide assistance to the

patient.

False

5. Maintaining confidentiality relates only to information about the patient. False

Chapter 2 Correct

Answer

1. Dementia can be cured. False

2. Alzheimer’s disease is the most common cause for dementia. True

3. Delirium is characterised by a sudden onset of change in a person’s mental function. True

4. People with dementia and delirium can be anxious and fearful when in hospital. True

5. It is important for volunteers to notify staff of any changes they notice in a person’s mental

state behaviour or physical condition.

True

Chapter 3 Correct

Answer

1. Dementia can affect a person’s ability to communicate. True

2. People with dementia may not be able to recognise familiar objects such as a cup or spoon. True

3. People with dementia don’t have emotions and feelings. False

4. Providing person centred care involves gaining an understanding of the person, their

background, personal preferences.

True

5. Completion of a person profile can greatly support volunteers in their communication with

patients.

True

QUIZ ANSWERS

QU

IZ A

NS

WE

RS


Chapter 4 Correct

Answer

1. The information on the patient’s personal profile can assist volunteers in deciding on

appropriate activities for the patient.

True

2. Sitting and talking with patients is not an activity. False

3. Distraction activities can assist with patients who may be unsettled or agitated. True

4. Playing a patient’s preferred music is an activity. True

5. Because patients in hospital are unwell, some will be sleepy and not be able to concentrate

on activities.

True

Chapter 5 Correct

Answer

1. Onset or change in behaviours can be common in patients with dementia and delirium. True

2. Wandering and agitation are not behaviours. False

3. There can be many causes or triggers for behaviours. True

4. Pain and fear are not causes for changed behaviour. False

5. Gaining an understanding of the person and trying to understand what they might beexperiencing are ways volunteers can support patients.

True

6. If a volunteer feels unsafe, they should stay calm, leave the room and report what has occurred to

staff.

True

Chapter 6 Correct

Answer

1. Patients with dementia and delirium are at risk of become dehydrated when in hospital. True

2. Coughing, gurgly voice, food residue left in the mouth are not signs of swallowing difficulties. False

3. The 3 types of texture modified fluids are: mildly thick, moderately thick and extremely thick. True

4. It is not important for the volunteer to check the patients menu to ensure it is the correct

meal.

True

5. Gaining an understanding of the person and trying to understand what they might beexperiencing are ways volunteers can support patients.

False

6. It is safe for a volunteer to feed a patient when they sleepy or drowsy. False

QU

IZ A

NS

WE

RS


QU

IZ A

NS

WE

RS

Chapter 7 Correct

Answer

1. Walking frames and walking sticks are the most common types of walking aids volunteers

will be involved with.

True

2. Volunteers can only walk with patients who are independent or require supervision. True

3. A volunteer can prompt or remind a patient about the right way to get out of a chair but

not physically assist.

True

4. Encouraging patients to walk regularly when it is safe for the volunteer to do so is an

important volunteer role.

True

5. If a patient has fallen, a volunteer can help them get up. False

6. Volunteers should always check with staff if they are unsure about anything. True

Documents

Volunteer Training Handbook · purpose of this handbook is to support your learning as you progress through the seven chapters of the DVD training resource. The seven chapters in